P24 A pharmacist-led acne service as a novel and highly effective model of care utilizing the full potential of a multiprofessional workforce
Authors: Sylwia Michlewska, Morag Herkes, Chandra Bertram, Nicola Salmon
Journal: British Journal of Dermatology (2023)

Abstract The aim of this study was to establish a pharmacist-led acne clinic in the dermatology department in our teaching hospital, evaluate its quality and measure patient satisfaction with the new service. Two pharmacist independent prescribers (PIPs) underwent training in dermatologist-led clinics. An acne service was established, where dermatologists refer patients to PIPs for a course of treatment with isotretinoin. A set of evidence-based quality indicators (QIs) was developed and peer-reviewed by a multidisciplinary team and then used to evaluate service quality. Adherence to QIs was established through retrospective review of medical records for all patients seen by PIPs over a 12-month period. Patient satisfaction with the pharmacist-led clinic was measured by administration of anonymized questionnaires over a 1-month period. Patients rated (poor, fair, good, excellent) 11 items and provided free-text comments. During a 12-month period, 81 patients [70% females, median age 23 years (range 14–44)] were referred to a pharmacist-led clinic and PIPs delivered 307 appointments, saving an estimated 100 h of dermatologist time. Five patients required an additional dermatologist appointment and seven required additional dermatologist advice. We report ≥ 90% adherence to 11 of 14 QIs focusing on isotretinoin prescribing and patient monitoring, including mental health assessment using the Patient Health Questionnaire-9 tool. We identified the lowest adherence to QI 5 (45%; a final pregnancy test 5 weeks after stopping isotretinoin); however, six female patients disengaged with the service without completing the treatment. We report 70% adherence to QI 3 [use of Medicines and Healthcare products Regulatory Agency (MHRA)-recommended contraception] and 76% adherence to QI 1 (indication for isotretinoin). Corrective measures were implemented to improve adherence to QI 5 (a patient invitation for a final pregnancy test) and QI 3 (patient consent form compliant with MHRA recommendations on contraception). PIP consultations were rated as excellent by 76% of responders with acne (69% response rate; 33 surveys completed). All free-text comments (n = 10) were positive, with one suggestion for improvement (booking appointments in advance). Thematic analysis of comments revealed appreciation of ‘care and compassion’ (n = 10), ‘multidisciplinary team service delivery’ (n = 4), ‘ensuring patient understanding’ (n = 3), ‘pharmacist knowledge’ (n = 3), ‘professionalism’ (n = 2) and ‘medical team input’ (n = 1). There have been no patient complaints or adverse outcomes related to the pharmacist-led acne clinic since it was launched. PIPs successfully deliver a high-quality acne service that increases the overall dermatology service capacity. Patients report high satisfaction and appreciation of PIP knowledge and skills. The developed QIs and patient satisfaction questionnaire can be used for quality monitoring by other clinicians.